重症监护室患者胃肠道产KPC-2肺炎克雷伯菌ST11株的分布调查及遗传相关性分析  

Distribution and genetic correlation analysis of KPC-2 producing Klebsiella pneumoniae ST11 in gastrointestinal tract of patients in intensive care units

作　　者：胡金曹[1] 曹小利[1] 万会林 周辉[1] 周万青[1] 李阳[2] HU Jincao;CAO Xiaoli;WAN Huilin;ZHOU Hui;ZHOU Wanqing;LI Yang(Department of Laboratory Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu;Department of Nosocomial Infection Control,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu;Department of Laboratory Medicine,Nanjing Gaochun People′s Hospital,Nanjing 211300,Jiangsu,China)

机构地区：[1]南京大学附属鼓楼医院检验科,南京210008 [2]南京大学附属鼓楼医院医院感染管理科,南京210008 [3]南京市高淳人民医院检验科,南京211300

出　　处：《临床检验杂志》2022年第11期817-820,共4页Chinese Journal of Clinical Laboratory Science

基　　金：国家自然科学基金(81902124);南京市卫生青年人才培养工程(QRX17059)。

摘　　要：目的分析产KPC-2肺炎克雷伯菌ST11株在南京大学附属鼓楼医院重症监护室(Intensive Care Unit,ICU)住院患者胃肠道的定植情况,并分析bla_(KPC-2)阳性肺炎克雷伯菌ST11菌株之间的遗传相关性。方法采集我院ICU患者的肛拭子,使用含有0.5μg/mL美罗培南的麦康凯平板筛选碳青霉烯耐药肺炎克雷伯菌,K-B法测定其对临床常用抗菌药物的敏感性;采用PCR法和DNA测序技术检测bla_(KPC-2)基因;多位点序列分型技术分析bla_(KPC-2)基因阳性肺炎克雷伯菌的序列分型(sequence type,ST),筛选出ST11菌株。脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)技术分析产bla_(KPC-2)肺炎克雷伯菌ST11菌株之间的遗传相关性。结果共收集肛拭子125份,30株(24.2%)为碳青霉烯耐药肺炎克雷伯菌。其中,27株(90.0%)携带bla_(KPC-2)基因,26株(86.7%)细菌为肺炎克雷伯菌ST11,25株(83.3%)细菌为产KPC-2肺炎克雷伯菌ST11株。PFGE结果显示,19株产KPC-2肺炎克雷伯菌ST11菌株之间有很大的遗传相关性。结论产bla_(KPC-2)肺炎克雷伯菌ST11株在我院ICU患者胃肠道中定植广泛,可能是其感染的主要病原菌,需加强感染控制措施。Objective To analyze the colonization of KPC-2 producing Klebsiella pneumoniae ST11 in the gastrointestinal tract of the patients in the Intensive Care Units(ICU)of Nanjing Drum Tower Hospital and the genetic correlation between bla_(KPC-2)positive K.pneumoniae ST11 strains.Methods The anal swabs of patients in the ICU of our hospital were collected,and carbapenem-resistant K.pneumoniae strains were screened with the MacConkey plates containing 0.5μg/mL meropenem.Their susceptibility to commonly used clinical antibiotics were determined by the K-B method.The bla_(KPC-2)gene was detected by PCR and DNA sequencing,and the sequence type(ST)of K.pneumoniae with positive bla_(KPC-2)gene was analyzed by the multilocus sequence typing to screen out ST11 strains.The genetic correlation between KPC-2 producing K.pneumoniae ST11 strains was analyzed by pulsed field gel electrophoresis(PFGE).Results A total of 125 anal swabs were collected,and 30(24.2%)strains were carbapenem-resistant K.pneumoniae(CRKP).Among them,27(90.0%)strains carried bla_(KPC-2)gene,26(86.7%)were assigned to be K.pneumoniae ST11,and 25(83.3%)were KPC-2 producing K.pneumoniae ST11.PFGE results showed that there was an obvious genetic correlation between 19 KPC-2 producing K.pneumoniae ST11 strains.Conclusion KPC-2 producing K.pneumoniae ST11 is widely colonized in the gastrointestinal tract of patients in ICU of our hospital,which may be the main pathogen of infection.Infection control measures should be strengthened.

关 键 词：肺炎克雷伯菌 ST11 KPC-2 重症监护室 碳青霉烯耐药 

分 类 号：R446.5[医药卫生—诊断学]